上睑成形术治疗泪腺脱垂并眼睑松弛症

目的 探讨泪腺脱垂并眼睑松弛症的手术矫正方法及效果。方法 28例（56眼），年龄17－43岁。采用上睑成形术治疗泪腺脱垂并眼睑松弛症：距睑缘6－8mm画出满意弧度的重睑线，切除多余皮肤，切除眶隔处脱出的眶脂肪，通过眶隔缩短加固使脱垂泪腺复于原位。结果 56眼术后均泪腺复位，重睑线美观，睑松弛症消失，随访6月至3年无复发。结论 此法操作简单，疗效满意。     

眼睑松弛症伴泪腺脱垂的手术治疗

目的探讨眼睑松弛症伴泪腺脱垂的手术矫正方法及效果，方法按照切开法重睑成形术设计手术切口，将脱垂的泪腺复位于眶外上方的泪腺窝内，然后去除上睑松弛的皮肤及疝出的脂肪，形成弧度自然、流畅的重睑。结果28例（56眼）上睑皮肤松弛得到充分矫正，恢复皮肤弹性，3例（4眼）术后6个月时在颞上方触到泪腺，目前仍处于观察中。结论治疗眼睑松弛症的重点是通过手术将汨腺复位下泪腺窝内，可达到美容与功能治疗的目的，手术效果稳定易于掌握。     

眼睑松弛症伴泪腺脱垂的手术治疗

目的 探讨眼睑松弛症合并泪腺脱垂的手术疗效.方法 采用双重睑切口的皮肤松弛矫正术联合泪腺复位固定术,对12例(24只眼)眼睑松弛症合伴泪腺脱垂患者进行手术治疗.结果 随访6月至6年,12例患者术后眼睑皮肤松弛均得到明显改善,泪腺脱垂,上睑下垂均得到满意矫正.结论 眼睑松弛症合并脱垂泪腺,采用双重睑切口的皮肤松弛矫正术联合泪腺复位固定术可有效改善其症状,实现患者美观与功能的双重疗效.     

矫正老年性睑内翻手术的改良

目的 观察矫正老年性睑内翻手术改良后的疗效。方法 选择老年性睑内翻39例（43眼），术前预先设计皮肤切除量，在局麻下，采用切除部分松弛皮肤和睑板前肌联合缝线法手术，术毕时观察眼睑位置，酌情行灰线切开术。结果 术后次日眼睑位置正常，术后随访6-12个月眼睑位置仍保持正常。结论 矫正老年性睑内翻手术的改良，不但可以恢复眼睑的正常生理功能，而且可以改善面部容貌，此方法可行。     

特发性眼睑松弛症的手术治疗

特发性眼睑松弛症常伴有泪腺脱垂或泪腺异位,是发生在中青年中的一种特殊类型的眼睑疾病。其发病早期,因只表现为“肿眼泡”而不易被发现,随着病程的延长,眼睑皮肤松弛变薄,外上眶缘可扪及一滑动的肿块,患者多在此临床表现期就诊。我院自2004年8月至2010年4月对12例（23眼）特发性眼睑松弛症进行了手术治疗,现报告如下：     

眼轮匝肌灼烙治疗痉挛性睑内翻合并结膜松弛

目的探讨眼轮匝肌灼烙术治疗痉挛性睑内翻合并结膜松弛症的临床疗效。方法对35例（65眼）痉挛性睑内翻合并结膜松弛症应用本方法。术前检查全部病例都表现干眼症状。其中角结膜炎20例（40眼）,角膜溃疡11例（11眼）。裂隙灯显微镜检查,眼表荧光素染色,泪河及泪膜功能障碍,氯霉素味觉检查异常。结果35例（65眼）术后随访3个月～2a,症状明显改善,32例（62眼）眼睑矫正良好,角结膜炎、角膜溃疡治愈;结膜松弛症好转,泪河、泪膜功能恢复,氯霉素味觉试验恢复正常58眼,占89．23％。结论本方法能有效矫正睑内翻,同时能使结膜松弛症及角膜病变得到治疗。     

眼睑皮肤松弛症及其伴发畸形的手术整复

目的 评价眼睑皮肤松弛症及其伴发畸形的手术整复效果.设计 回顾性病例系列.研究对象 35例(52眼)眼睑皮肤松弛症稳定期患者.方法 所有患者实施上睑畸形矫正术,做上睑重睑切口,切除多余松弛皮肤及眶脂肪,18例(36眼)联合行泪腺脱垂复位术;10例(16眼)联合上睑下垂矫正术.4例(6眼)行下睑缩矫正术.7例(14眼)行外眦畸形矫正术,联合或二期行眼睑皮肤松弛矫正或上睑下垂矫正术.主要指标 双眼重睑形态,眼睑位置,眼睑运动功能,泪腺的位置,有无泪液分泌异常.结果 随访6～60个月,所有患者双眼上睑重睑基本对称,双上睑形态良好,眦角位置接近正常,无溢泪及干眼症状.2例(3眼)患者于术后29及36个月复诊时发现泪腺脱垂复发,再次行泪腺脱垂复位术,术后分别随访18、24个月,未发现泪腺再脱垂.结论 采用眼部整复手术矫正眼睑皮肤松弛症及伴发畸形安全有效,术后复发率较低.     

瘢痕性睑外翻的手术矫正

目的探讨瘢痕性睑外翻手术矫正的临床疗效。方法采用眼睑瘢痕切除、睑缘延长量楔形切除及游离植皮的方法,对23例（43眼）因瘢痕性睑外翻进行手术矫治,并观察其临床效果。结果本组伤后1～2个月手术5例（9眼）,〉6个月手术17例（32眼）,术后植皮成活良好,3例（3眼）于手术后1个月发生轻度睑裂闭合不全,无睑缘外翻,未处理;2例（2眼）于2个月后因面部瘢痕挛缩致使睑外翻,需再次手术处理;余经6个月～4年随访,效果良好。结论根据眼睑皮肤缺损大小,睑缘延长量多少设计手术方法,取耳后、锁骨上窝或上臂内侧全厚皮片、游离皮片修复睑皮肤缺损,效果良好。     

次全闭睑肌切除手术治疗眼睑痉挛的疗效及常见并发症

目的观察次全闭睑肌切除手术治疗眼睑痉挛的疗效及常见并发症。方法回顾性分析不能通过肉毒杆菌毒素A注射得到治疗的10例（20眼）眼睑痉挛次全闭睑肌切除手术的临床疗效及常见并发症。结果90％病人解除了手术前开睑不能的临床症状，可以维持日常生活；同时眉下垂、上睑下垂、外呲韧带松弛、眼睑皮肤松弛得以解除。     

多次Z字皮瓣在眼睑皮肤缺损的应用

目的探讨多次Z字皮瓣在较大眼睑皮肤缺损的应用效果，提出新的手术方式。方法眼睑皮肤缺损31例（38眼）使用多次Z字皮瓣进行修复。结果31例（38眼）眼睑皮肤缺损修复良好，未形成眼睑畸形，不影响眼睑的美容和功能。结论多次Z字皮瓣可以较好地修复眼睑皮肤缺损，保持眼睑功能及外观     

Doxycycline for treatment of blepharochalasis via inhibition of matrix metalloproteinases

Two cases of blepharochalasis were studied. In Case 1, a 16-year-old male presented with the history and clinical features of blepharochalasis. A positive tissue biopsy for matrix metalloproteinases suggested a benefit from treatment with doxycycline. The patient remained disease-free for 18 months following commencement of doxycycline. In Case 2, a 21-year-old male with a 5-month history of swelling affecting his upper eyelids was diagnosed with blepharochalasis. He received an 8-month course of doxycycline and remained symptom-free on review 2 months after treatment cessation. While the pathogenesis of blepharochalasis has remained uncertain, an immune mechanism has been suspected. The presence of matrix metalloproteinases in the tissue biopsy of our first patient supports such an immune mechanism. As doxycycline inhibits matrix metalloproteinase activity, it may provide an effective and well-tolerated treatment alternative for cases of blepharochalasis for which surgery has previously been the only treatment option.     

两种手术方式治疗退行性下睑内翻伴眼睑松弛的疗效比较

目的：分析并比较改良式眼轮匝肌缩短术及单纯眼轮匝肌缩短术治疗退行性下睑内翻伴眼睑松弛的临床疗效。

方法：选取2012-01/2014-08我科收治的93例108眼退行性下睑内翻伴眼睑松弛为研究对象,根据手术方式的不同分为观察组(47例52 眼,采用改良式眼轮匝肌缩短术)和对照组(46例56眼,采用单纯眼轮匝肌缩短术)。比较两组患者的短期和长期治疗效果。

结果：观察组与对照组患者在年龄、性别及病程方面比较,差异无统计学意义(P>0.05)。观察组的短期有效率(98%)与对照组(95%)比较,差异无统计学意义(P>0.05); 观察组术后3a的复发率(2%)低于对照组(14%),差异有统计学意义(P=0.033)。

结论：改良眼轮匝肌缩短术治疗退行性下睑内翻伴眼睑松弛较单纯眼轮匝肌缩短术的临床疗效好。     

Blepharochalasis with multiple system involvement.

A rare case of bilateral blepharochalasis of the upper eyelids is presented in a 10-year-old boy with several systemic abnormalities--unilateral agenesis of the left kidney, multiple skeletal anomalies of the vertebral column, and congenital heart disease with a left to right shunt. Such widespread congenital defects in association with blepharochalasis have not been described before. Blepharochalasis may represent a part of a more generalised disorder.     

Floppy eyelid syndrome and blepharochalasis

Floppy eyelid syndrome and blepharochalasis may represent a spectrum of one underlying disease. Two patients with floppy eyelid syndrome and one with blepharochalasis shared important clinical similarities. All three patients displayed eyelid laxity associated with papillary conjunctivitis and ocular surface abnormalities. Histopathologic findings were similar in the three cases, characterized by chronic conjunctival inflammation with normal tarsal collagen. In all three patients surgical horizontal eyelid shortening led to improvement in symptoms and findings.     

特发性睑皮松驰伴泪腺脱垂的诊断和手术治疗

目的　通过26 例睑皮松驰伴泪腺脱垂的病例分析,探讨此疾病的部分成因,以及合理的手术方法。方法　用手术的方法使脱垂的泪腺复位至泪腺窝,同时对眶隔进行加固来减轻眶隔的松驰造成的眼睑膨隆,并对上睑松驰的皮肤进行充分的切除和正确的缝合,来彻底改善病人的外观。结果　26 例52 只眼术后睑皮肤松驰得到矫正,皮肤弹性得到一定恢复,外观有很大的改善。48 只眼的眼睑膨隆得到改善,4 只眼于上睑颞侧穹隆部可见重又脱垂的泪腺。结论　通过对这些病例的分析和手术矫治,使我们对此种疾病的病因、诊断及手术关键有了很好的认识     

Blepharochalasis.

The condition of blepharochalasis and its treatment are discussed. Four cases are presented which show a physical sign that may help in its diagnosis.     

Discrepancy between objective measurement and subjective recognition of sicca syndrome before and after blepharochalasis operation for cosmetic or medical reasons

BACKGROUND: This study was designed to examine if patients undergoing the same operative procedure (blepharochalasis operation) have different subjective recognition of dry eye problems depending n whether they had he operation for cosmetic or medical reasons. PATIENTS AND METHOD: The study included 32 patients (25 women, 7 men, mean age 57.8 +/- 12.1 years), who underwent blepharochalasis operation between 1/2005 and 5/2005. In 17 patients (group 1) the operation was done for cosmetic reasons, in 15 patients we found a medical indication (group 2). We evaluated the subjective discomfort from the lid problems as well as the satisfaction with the operation in general and pre- or postoperative recognition of dry eye problems (all done by scales). Additionally we measured tear secretion by Schirmer's test and break-up time before and after operation. RESULTS: The subjective recognition of a dry eye was stronger in group 1 than in group 2 before and after operation (p < 0.005), but objective data were nearly identically (BUT, Schirmer's test). CONCLUSION: When operated due to cosmetic reasons the stronger recognition of sicca problems (while objectively lacking) is may be caused by a stronger fixation on the lid disease itself. It seems necessary to document objective data for that reason.     

Herniation of the lacrimal glands

Herniation of the lacrimal gland is an unusual condition which has a predilection for blacks and is associated with blepharochalasis. It is benign and tends to become progressive. Either or both lobes of the lacrimal gland can herniate and must be differentiated from dermolipoma and orbital fat. A surgical treatment is described, and three cases are presented.     

眼睑皮肤松弛综合征临床研究进展

眼睑皮肤松弛综合征是一种较少见的眼睑疾病,表现为青少年时期特发性局限性眼睑皮肤反复间断性无痛性血管神经性水肿,反复水肿破坏眼睑组织结构导致眼睑皮肤松弛变薄,毛细血管增多迂曲扩张以及后期上睑下垂、眶脂肪脱垂、泪腺脱垂等多种并发症。眼睑皮肤松弛综合征的发病机制尚不明确,可能存在遗传等因素的参与;组织病理学研究发现IgA沉积和基质金属蛋白酶活性表达增强,提示免疫反应参与弹性纤维的降解,后者进一步引起局部淋巴系统结构功能的改变;这些因素共同参与了本病的发生发展。眼睑皮肤松弛综合征的治疗分为急性水肿期和稳定期的治疗。